Emergency Care Capacity in Pediatric Hospitals, Khartoum, Sudan

@#Introduction: Critical pediatric patients have specific needs, which require special skills, training, equipment, supplies, personnel, and medications. While the knowledge related to enhance survival rate of newborn and children has improved over the past few decades. This study conducted to assess the emergency care capacity in pediatric hospitals at Khartoum state, Sudan. Methods: This is a descriptive cross-sectional hospital-based study, it was conducted in three hospitals at Khartoum, Sudan 2017-2018, to assess emergency care capacity in pediatric hospitals. Data was collected using open-ended questionnaire, and observational checklist. The data scored using dichotomous indicators (absent or present). Results: The study showed that there is shortage in human resources necessary to provide emergency care. However, much essential equipment for emergency care of children was absent in most hospitals, moreover, only 33% of hospitals had Triage system staffed by a trained person. Further, the clinical practice protocols for managing dehydration, neonatal sepsis, and neonatal resuscitation were not traced at the three hospitals. There are a limited laboratory services in one hospital. Conclusion: It is concluded that pediatric specialized hospitals, in Khartoum state, Sudan, have low capacity to provide emergency care for children. Further efforts are needed to improve the emergency care capacity in Khartoum hospitals.

Measuring nurses' satisfaction in primary health care centers at Khartoum, Sudan

Background: The primary healthcare sector has experienced significant growth globally, and the nursing workforce has also expanded in recent decades in response to health system reforms. This study aims to assess job satisfaction among primary healthcare nurses in Khartoum, Sudan. Methods: This descriptive cross-sectional study was conducted in 10 primary healthcare centers on 50 nurses who were selected using simple random sampling. Data were collected using an online questionnaire and it was analyzed using SPSS. Results: The findings of this study indicate that the job satisfaction level among nurses working at primary healthcare centers in Khartoum was high (4.4/5). Most nurses reported high satisfaction with all items including protocols, salary, environment, and relationships. The study also found a significant correlation between nurses' sex and experience with their level of job satisfaction. Female nurses reported significantly higher job satisfaction (4.4/5) compared to male nurses (3.6/5), (p-value = 0.04). Additionally, nurses with fewer years of experience reported significantly higher job satisfaction compared to those with more years of experience (p-value = 0.03). Conclusion: The study concludes that nurses working at primary healthcare centers in Khartoum have high job satisfaction, particularly regarding the working environment, salary, relationships, and availability of guidelines. Female nurses and those with less experience have significantly higher job satisfaction.

Adherence to Immunosuppressive Medications in Kidney Transplant Patients at Three Centers in Khartoum State, Sudan: A Cross-sectional Hospital Study

Background: Graft survival post-kidney transplantation is of paramount importance to patients and nephrologists. Nonadherence to immunosuppressive therapy can be associated with deterioration of renal function and graft rejection. This study aimed to evaluate the adherence to immunosuppressive medications in kidney transplant patients at three centers in Khartoum, Sudan. Methods: In this descriptive cross-sectional hospital-based survey, 277 post-kidneytransplant patients were recruited. Data were collected using a questionnaire and analyzed using the SPSS v.23. Our scoring method was calculated based on Morisky Medication Adherence Scale (MMAS-8) related to immunosuppressive medications and was expressed as questions in the questionnaire; every correct answer was given one mark, then the marks were gathered and their summation was expressed. Results: Overall, 33% ,45%, and 22% of the studied participants reported high, medium, and low adherence, respectively. The major factor for nonadherence was forgetfulness affecting 36.1% of those who did not adhere. The cost of the immunosuppressive medications did not negatively affect any of the participants' adherence (100%). However, a significant association was seen between adherence and occupational status, duration of transplantation, shortage of immunosuppressants, recognizing the name of immunosuppressant, side effect, and forgetfulness (P-values = 0.002, 0.01, 0.006 , 0.000, 0.022, and 0.000, respectively). Logistic regression analysis showed a significant association with occupational status, side effects, and forgetfulness.

Self-Medication with Antibiotics and Its Predictors among the Population in Khartoum Locality, Khartoum State, Sudan in 2018

Background: Self-medication is a personal self-initiated behaviour of diagnosis of a disease and self-treatment of its symptoms and signs.Objective: Toidentify the prevalence of self-medication with antibiotics and the diseases commonly treated with antibiotics, the most commonly used antibiotics, the sources of obtaining it and the predictors of self-medication with antibiotics.Study Design: This was a cross-sectional, descriptive study.Place and Duration of Study: This study was conducted in Khartoum Locality, Khartoum State, Sudan during April 2018.Methods: 246 adults (130 males, 116 females) over 18 years were included in the study. A closed-ended, pretested and pre-validated questionnaire was used to interview the participants.Data was analysedusing SPSS Version 23.0. Descriptive statistics were presented in tables and figures. Logistic regression was conducted to identify the predictors of self-medication with antibiotics. Ethical approval and voluntarily signed consent were obtained prior to embarking on the study.Results:148(60.2%) participants practiced self-medication with antibiotics, 111(75%) of whom obtained the antibiotics over the counter in community pharmacies. The most commonly used antibiotic was amoxicillin/clavulanic acid (38.5%). The major reason behind taking antibiotics without prescription was long distances to healthcare facilities (43.2%). The commonest symptom which encouragedself-medication with antibiotics was abdominal pain (27%). Females were 3.55 times more likely to use self-medication with antibiotics than males. Participants who lacked health insurance cards were 2.65 times more likely to practice self-medication with antibiotics.Conclusion:The prevalence of self-medication with antibiotics is alarmingly high in Khartoum Locality. Over the counter purchase of antibiotics was the main route of self-medication. Gender and lack of health insurance were significant predictors of self-medication. Mass education through different media and policy reform are recommended.

Socio-demographic Characteristics, Risk Factors and Awareness of Adults Hypertensive Population in Khartoum Locality, 2014

Aims: To identify the prevalence of hypertensions, socio demographic characteristics, risk factor and awareness of the study population about hypertension in Khartoum Locality.Study Design: A descriptive community-based cross-sectional study.Place of Study: Khartoum locality, Sudan.Methodology:A total of 587 adult participants were interviewed using structured close ended questionnaire. Blood pressure was measured considering hypertension as ≥ 140 mmHg and ≥ 90 mmHg for systole and diastole blood pressure respectively. Body Mass Index (BMI) was calculated and the cutoff points were derived from World Health Organization (WHO) reference criteria to classify BMI as normal, overweight and obese. Chi square test was used to assess the association of socio demographic characteristics and risk factors with hypertensive population.Results: The prevalence of hypertensive accounted to 216 (36.8%). Thirty seven hypertensive participants (17%) were not aware about having hypertension, 86 (40%) were not aware about at least one complication of HTN and 117(54%) were not aware about the normal measures of blood pressure. The hypertensive participants were significantly high in the age group 25-64 years of age and above. Females were significantly having hypertension more than males, 155 (72%) versus 61 (28%). Married participants were significantly having hypertension more than non-married, 169(78%)and 47(22%) respectively. Unemployed participants were significantly having hypertension more than employed ones, 168 (77.8%) and 48 (22.2%) respectively.Risk factors among hypertensive participants were significantly found among overweight 67 (31%) and obese 115 (53%), positive family history of hypertension 139 (65%), increase salt in food149 (69.3%) and physical inactivity 166 (77%). Conclusion: The prevalence of hypertension among Khartoum locality was high. Hypertensive population awareness was low. Age, sex, marital status, education andemployment weresignificantly associated with hypertensive population. Obesity and overweight, family history of hypertension, increase salt in food and physical inactivity were risk factors among hypertensive study population.Keywords: Socio-demographic;awareness;risk factors;hypertension;Khartoum locality.1. INTRODUCTIONHypertension is positioning the first rank of causes of deaths worldwide [1]. It is a public health problem with an increasing global prevalence, especially in low and middle income countries [2,3]. Attributable factors related to the increasing prevalenceof hypertension includefast population growth and ageing, consumption of unhealthy diets, lack of physical exercise, obesity and increasing life stresses[2]. In sub-Saharan Africa, the burden of hypertension has been increasing continuously with prevalence varying widely between 15% and 70 % [4-6].Sudan witnessed rising prevalence of hypertension during the past few years [7,8]. Hypertension is the silent killer that screening and early detection could prevent or reduce its serious complications, including stroke, ischemic heart disease, congestive cardiac failure, sudden cardiac death, peripheral vascular disease and renal insufficiency [9].Most persons with hypertension are not aware of their hypertensive disease, which increase the chance of being presented for the first time to health institution by complications [10,11]. Awareness of population about hypertension is high in developed countries compared to developing nations. Awareness of population about their hypertensive status is an important determinant of adherence to anti-hypertensive medication as well as increasing the knowledge regarding the risk factors and modifying the negative lifestyle habits [11-13]. The increase prevalence of hypertension in Sub-Saharan Africa could be related to inadequate information about the disease that contributes to low awareness of population about their hypertensive status [14]. It was found thatawareness about hypertensive status was low among hypertensive population with low socio-demographic characteristics [15]. Few recent studies in Sudan were carried and did not emphasize the association of socio demographic characteristics to hypertensivestatus and the awareness of hypertensive adults about their hypertensiondisease.The aim of the study was to identify the prevalence of hypertension, socio demographic characteristics, risk factor and awareness of the study population about hypertensionin Khartoum Locality.2.POPULATION AND METHODS2.1 Study DesignThis was a descriptive community-based cross-sectional study.2.2 Study AreaThe study was carried out in Khartoum locality which spread approximately across 176 square kilometers area and inhibited by 639,598 of the population. Khartoum locality is one of the seven localities in Khartoum State. It consists of six local administrative units and 157 blocks.

Factors Related to Deaths of under 5 Years Old Children in Dar Alsalam Area-Khartoum-Sudan

Aims: This study is done to identify factors affecting under five mortality in Dar Alsalam area, Khartoum.Study Design:This is a community based cross-sectional study.Place and Duration of Study:The study was carried out in block 25 in Dar Alsalam area in Khartoum State during March-April 2012.Methodology: A total of 240 women in reproductive age who had an experienceof child death were interviewed. The data was collected by semi-final medical students using structured questionnaire. Two stage cluster sampling was used to select the households. Data was summarized using descriptive statistics and logistic regression analysis was carried out to identify factors associated with under-five mortality.Results: Age of 156 (65%) of the deceased children was less than one year, while the age of 84 (35%) was between one and five years. The age of (25%) of the motherat the time of their child birth was below 18 years. The majority of the mothers (70.8%) were illiterate, 74.2% were working and 80% were married. Of the children 51.7 were males and for 74.2% of them the birth interval was less than 2 years. Only 16.7% were breast fed for more than two years while the rest (83.3%) were breast fed up to 2years. Only 34.2% of the deceased children had completed their vaccination, and 68.3% had been admitted to hospital more than once before death.Half of the families have piped water in their houses, in 75.8% of the houses there are pit latrines andin68.3% there is electricity supply. Logistic regression analysis identified incomplete vaccination, not employed mothers and having no latrines in the house as the factors related to the death of children between 1-5 years than those below one year.Conclusion: Under-five mortality in low socioeconomic areas is associated with Low family income, mother’s illiteracy, early marriage and absence of latrines in the houses.

Quality of Life of Diabetic Children in Public Diabetes Specialized Clinics, Khartoum State, Sudan

Background:Quality of life assessment can be a good baseline measures to determine the efficacy of health policies that are designed to reduce or eradicate the detrimental disease effect.Aim: This study aimed at assessing the different dimensions of quality of life in children with diabetes including physical, social, emotional and school function.Methods: Thestudy was conducted in Khartoum state -Sudan using a cross sectional design. Data was obtained in 2018 at three outpatient diabetes clinics, using systematic random sampling with sample size of 138 diabetic children aged between 2-18 years, via structured interviews. Descriptive and inferential statistics were used to analyze the data and test the relationship between quality of life and other independent variables: demography ( age, gender, parents’ education, age, residency and occupation), type of diabetes, typeof treatment, duration of illness, control of diabetes and insurance statusResults:The mean age of children was 11.1±3.64 years. Most of them were females 63%. More than half of participants were not covered by any insurance scheme. Those with diabetes reported personal and adverse social effects, poor control; HA1C more than 6.5% in 90% of participants. Mean generic quality of life was 80.03 ± 27 and 80.84 ± 28 p-value =0.73 for parents and children respectively. Conclusion: Diabetes adversely affects the quality of life of diabetic children which is influenced by history of hospitalization. Further studies on Diabetes quality of life are recommended.

Prevalence and factors associated with syphilis among pregnant women attending antenatal care, Khartoum State, Sudan

Background: The aim of this study was to determine the seroprevalence, predisposing factors of syphilis among the pregnant women attending antenatal care service, Khartoum state 2009.Methods: Descriptive cross- sectional study conducted among a simple random sample of 700 pregnant women attending antenatal care (ANC) services in Khartoum State health facilities. The data were collected by a questionnaire and blood samples investigation by using the Rapid Plasma Reagent Test (RPR). Descriptive method as well as inferential statistics were used for data analysis.Results: Most of the respondents were housewives (90.7%). (92%) of them were married for the first time, 81.1% had formal education. 39% know nothing about syphilis. Only 13.5 % knew the right causative agent, but some of them had information about the ways of protection. 38% of them had knowledge about unsafe or unprotected sex. 26% mentioned that having sex with one partner is very important for their safety. The most common sources of their information were friends followed by TV, radio and health personal. The overall Syphilis sero-prevalence was (3%). (63.6%) of the respondents knew about the possibility of transmission from the infected pregnant mother to her child. only (44.6%) of them heard about condoms, of them only (47.3%) had seen condoms and (50.8 %) knew from where to get it. 33.3% had used the condoms. (3%) of the participating pregnant ladies stated that they had sex outside the marriage and (73%) of them had it during marriage.Conclusions: The main recommendations were to augment syphilis diagnosis and treatment in antenatal care service and sexually transmitted disease programs, and to conduct effective health education programs to raise the awareness about the disease, its prevention and control to the good of the pregnant ladies and to the community at large.

Burden and Pattern of Cancer in the Sudan, 2000-2006.

Aims: The aim of this study is to determine the number of newly diagnosed cancer cases and their distribution in two cancer-care providing facilities in Sudan. Study Design: This is a retrospective descriptive study. Methodology: Data was retrieved from patients’ records that were diagnosed and treated at the Radiation Isotope Center in Khartoum (RICK) and National Cancer Institute at Wadmadani (NCI -UG) in Sudan over the period between 2000 and 2006 and then statistically analyzed. Results: A total of 26652 cancer cases were retrieved with a noticeable increase in numbers from year 2000 to 2006. The maximum cancer number was observed in 45-64 year age group in both male and female patients with a male to female ratio of 1.3:1.0. The most common cancer sites for females were: the breast (29.3%), cervix uteri (8.2%), leukemia (7.2%), ovary (6.8%), and esophagus (5.9%) and for males: were prostate (7.6%), followed by leukemia, (7.0%), NHL (6.8%), esophagus (5.4%) and bladder (4.4), while leukemia (25.2%), NHL (12.4%), lymphoma (10.8%), retinoblastoma (6.6%) and brain tumors (3.3%) dominated in younger patients (<14 years old). Conclusions: This study provided some knowledge about the cancer situation in two institutions providing cancer care in Sudan that may draw attention of policy maker and aid in formulating appropriate cancer-control strategies in the country.